Health Care Information Management
Medical Insurance – Types
Learn hands-on skills to enter as an entry level Insurance Biller and Basic Coder and will be prepared for certification as a Certified Billing and Coding Specialist. This course may be taken by itself or with Medical Insurance – Billing.
16 Days
64 Hrs
7 Lessons
Agenda
- Describe the Federal Standards under HIPAA (Health Insurance Portability and Accountability Act)
- Explain the privacy rule as it pertains to protected health information
- Illustrate the difference between privileged and non-privileged information
- Explain the difference between a notice, a consent and an authorization
- List various types of insurance fraud
- Define abuse as it relates to the subject of billing and insurance claims
- State the guidelines for HIPAA privacy compliance
- Define a prepaid health plan
- Identify types of managed care health plans
- Explain health maintenance organization benefits and eligibility requirements (HMO)
- Define independent practice associations (IPA)
- Name the elements of preferred provider organizations (PPO)
- Explain eligibility criteria for Medicare
- Name important information to abstract from a patient’s Medicare card
- Explain an ABN (advanced beneficiary notice)
- State the benefits and drawbacks for participating vs non-participating physicians
- Calculate a payment for a procedure using a conversion factors (RBRVS)
- Determine the time limit for submitting a Medicare Claim
- Know whether Medicare is primary or secondary when there is more than one insurance
- List CMS-1500 block numbers that require information when submitting Medicare/Medi-Gap claims
- Post information on the patient’s financial accounting record from a Medicare EOMB
- Define terminology relating to Medicaid
- Interpret Medicaid abbreviations
- Name Medicaid eligibility classifications
- List important information to abstract from the patient’s Medicaid card
- File claims for patients who have Medicaid and other coverage
- State who is eligible for Tricare and ChampVA
- Define pertinent Tricare and ChampVA terminology and abbreviations
- Enumerate the differences between the various Tricare programs
- Identify the difference between the Tricare and ChampVA programs
- List the circumstances when a Non-Availability statement is necessary
- Describe how to process claims for individuals who are covered by Tricare and ChampVA
- State the purpose of workers compensation laws
- Describe the types of compensation benefits
- Define the different stages of disability under the workers compensation system
- Complete a Doctor’s First Report of Occupational Injury or Illness
- Realize that workers compensation differs from state to state
- State the role of ICD-9-CM – Volume 3 – in regard to hospital billing
- Identify categories in ICD-9-CM Volume 3
- State when the Uniform Bill (UB-92) paper and electronic claim forms may or may not be used
- State the general guidelines for completion of the paper UB-92 and transmission of electronic claims
- Identify how payment is made based on DRGs (Diagnosis Related Groups)
- Express knowledge of APCs (Ambulatory Payment Classifications)
FREE
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Course Type: Instructor Led